Contact Information

Name*
Email*
Phone #*
Address

Registration Info

Gender*
Birth date*
Health Card #
License Plate #
Allergies / Dietary Needs

Emergency Contacts

Name*
Phone*

Name*
Phone*


Accommodation Preference & Roommate Request

Every effort will be made to accommodate preferences, but there are a limited number of spaces in some categories.

Accommodations:
Roommate 1:
Roommate 2: